Background Percutaneous endoscopic gastrostomy (PEG) is an important route of nutrition in many patients. PEG removal usually leads to spontaneous closure in a few days. Gastrocutaneous fistula (GCF) after PEG removal is an uncommon complication occurring in 2% of patients. Despite its rarity, it is responsible for significant morbidity and reduced quality of life. Treatment is initially focused on medical management and endoscopic clipping, with advanced endoscopic techniques and surgery reserved for selected cases. Method We present a video presentation demonstrating successful endoscopic treatment of GCF using the OVESCO Over the Scope clip with resolution of symptoms and closure of the fistula tract. The device is a novel innovation designed to achieve tissue apposition and compression without ischaemia. It is licensed for Gastrointestinal iatrogenic defects, endoscopic perforation, bleeding and GCF. The 72 year old patient had debilitating symptoms of gastric leakage for over a year despite previous attempts at endoscopic clipping, fibrin glue and curettage of the fistula tract. Results As shown in the video, the clip achieved good opposition with no post procedural leak. The patient was reviewed at 3 and 12 months with no recurrence of their symptoms. The external cutaneous opening had closed at 3 months. The patient reported an increase in weight, improved mood and a greater quality of life following the intervention. Conclusion The OVESCO clip has been proven to facilitate successful endoscopic closure of GCF in selected patients in whom initial treatment measures have failed. This mitigates the need and risks of surgical closure.

Aims To limit exposure risk in view of the current COVID-19 pandemic, telephone clinics have become the mainstay of outpatient assessment. Although there is data from primary care, there is little evidence for the suitability of telemedicine within General Surgery. The lack of clinical examination can be dissatisfying for both patient and surgeon. The aim of this study was to explore patient satisfaction from telephone clinics in a General Surgery setting. Methods Data was collected prospectively from general surgery clinic appointments by a single surgeon in a District General Hospital from September 2021. Demographic data was obtained in addition to a short questionnaire at the end of their consultation. Patients were asked to score their experience out of 5 (5 being most favourable) and their preference in comparison to face to face appointments. Results 156 patients were included in the study, of which 95% of patients were contactable. 98% of patients gave the experience a satisfaction score of 3 or more out of 5. The median satisfaction score was 5. 97% expressed a preference over a Face-to-Face appointment. 7% of patients required a further Face-to-Face consultation and this group were more likely to have a lower patient satisfaction score. Conclusion Telephone clinics within general surgery achieve excellent satisfaction for the majority of patients. The patient experience could be further optimised by careful selection of patient suitability for the service. The data provides supportive evidence to the NHS Long Term Plan to reduce Face-to Face outpatient appointments by one third before 2024.